Clinical Review Specialist

THIS IS A NEW ASSEMBLED EXAMINATION.  The eligible list resulting from this examination will cancel any existing list and may last approximately one year, but can be extended.

Applications must be in the possession of the Human Resource Services Department by 5:00 p.m. on the Last Day for Filing. Applications will only be accepted on-line.

Supplemental Questionnaire:  A properly completed Supplemental Questionnaire must be submitted with each application.  Applications and Supplemental Questionnaires must be in the possession of the Human Resource Services Department by 5:00 p.m. on the Last Day for Filing. Failure to submit the Supplemental Questionnaire will result in disqualification.

HEALTH CARE SERVICES AGENCY

Alameda County's Health Services Program is administered by the Health Care Services Agency and includes the following program areas: Behavioral Health Care, Public Health, Environmental Health, and Agency Administration/Indigent Health. The ultimate mission of the Health Care Services Agency is to provide fully integrated health care services through a comprehensive network of public and private partnerships that ensure optimal health and well-being and respect the diversity of all residents. Health Care Services Agency currently has multiple career opportunities for experienced professionals to become part of a service delivery team dedicated to the optimal health and well being of Alameda County residents. 

BEHAVIORAL HEALTH CARE SERVICES  

It is the mission of Behavioral Health Care Services to maximize the recovery, resilience and wellness of all eligible Alameda County residents who are developing or experiencing serious mental health, alcohol, or drug concerns. We envision communities where people realize their potential, and where stigma and discrimination against those with mental health, alcohol and/or drug issues are a thing of the past.  For more information about the department of Behavioral Health Care Services, please visit the BHCS departmental website and/or Annual Budget Document found on acgov.org.

THE POSITIONS

We are seeking to fill at least two (2) Clinical Review Specialist positions located in the ACCESS Program and anticipate hiring additional Clinical Review Specialists in the near future for positions located in the Department of Behavioral Health Care Services ACCESS Program, Authorization Services and Quality Assurance units. Under general direction, Clinical Review Specialists provide behavioral health care services by telephone, face-to-face, and/or record review for referral, treatment, and/or payment authorization and service integration; gather and analyze case history data and treatment plans; make treatment recommendations and assess quality of care; record all findings and maintain review records; and perform related work as required.  These positions provide a variety of clinical services including screenings, assessments and referrals, review of medical necessity for authorization of services, utilization review, assessment of quality of care, and provider consultation.

DISTINGUISHING FEATURES

This is a journey level class, requiring a licensed professional, fully trained and professionally skilled upon entrance into the class. This position reports to a licensed clinical manager. Direct supervisory review and guidance is provided only in selected cases. Clinical Review Specialists provide behavioral care clinical assessment, clinical analysis, referral for treatment, treatment review, and provider consultation involving considerable latitude and independence of judgment. Incumbents in this class may lead and consult with other staff on clinical issues but do not have formal supervisory responsibility.

The class is distinguished from Behavioral Health Clinician II, Clinical Psychologist and Clinical Nurse II positions in that incumbents usually perform tasks using indirect information to provide behavioral health screenings and referrals or clinical direction to other licensed professionals and a large network of independent practitioners and organizations. This direction may include payment authorization, resource utilization management, quality improvement, quality assurance and coordination of multiple funding sources to support treatment requests.

EXISTING VACANCIES

The immediate vacancies for this position are in the ACCESS Program; however, please note that the eligible list resulting from this recruitment and selection process may be utilized for other future vacancies which may arise throughout Alameda County within the next year for this and other County Departments. 

ACCESS Program-  We are seeking to hire two (2) Clinical Review Specialists within the ACCESS Program to serve as an initial point of public contact and provide telephone information, screening, assessment and referral services to the greater Alameda County community.  The licensed clinicians at ACCESS generally work in a call center setting, hear concerns over the telephone, and provide clinical screenings and referrals to identified service providers within the County's network who can best meet the specific needs of each individual client, including language and communication needs.  An ACCESS Clinical Review Specialist may also be placed in an alternative setting to provide face to face assessments and referrals. These positions authorize treatment; assess for level of care; maintain records; provide consultation concerning medical necessity and utilization of system resources; and provide telephone crisis intervention services including arranging for emergency services when needed.  

Authorization Services  -  We are seeking to hire at least one (1) Clinical Review Specialists within Authorization Services to provide daily case consultation and review to determine medically necessary treatment and appropriate utilization of system resources for both inpatient and outpatient behavioral health services.  They are expected to consistently assess level of care, treatment and disposition plans based on cultural, developmental and age-related parameters; assure in each medical necessity review that adequate documentation exists to substantiate provision of services and payment authorization; and obtain information and documentation that is required to conduct pre-service, admission and continued stay hospital reviews including determination of aftercare planning and placement efforts.    

Quality Assurance  -  We are seeking to fill at least two (2) Clinical Review Specialist within Quality Assurance to assess the quality of care and documentation required to support continued client behavioral health care treatment; manage audits (internal and DHCS/EPSDT) ; investigate complaints; review sentinel events; monitors compliance with regulations including: documentation, HIPAA, chart reviews, utilization reviews, grievance tracking/reporting, change of provider requests, site certification, and provider license verification; responds to provider questions about documentation standards, claiming, staff qualifications and other inquiries into regulations; revise and write manuals and procedures; work with other departments on Quality Assurance initiatives and special projects; and collaborate with and provide service providers training.

IDEAL CANDIDATES

In addition to the minimum qualifications and knowledge and skills listed below, ideal candidates for these positions will be licensed clinicians with at least 3 years of post license clinical work experience within a health care call center, quality assurance or utilization review setting; and who has excellent communication and interpersonal skills to support their ability to interact well with others to earn their trust within an environment that embraces diverse cultures, interpersonal styles, abilities, motivations, and backgrounds.

Ideal candidates for these positions will also be highly respected as: 

• Licensed and experienced clinical professionals who are adept at securing relevant client care data and identifying key issues and relationships in a behavioral health managed care setting; who understands the relationships among assessments, interventions, and patient responses; and who are skilled in conducting behavioral health assessments and utilization and quality assurance reviews in order to refer clients to or evaluate medical necessity of services within the Alameda County network of service providers.
• Professionals who would take personal satisfaction and pride representing the County and serving as part of a team directly responsible for either providing initial clinical screening and service referrals over the telephone in a fast-paced, high volume call center environment or providing quality assurance and utilization review of clinical resources.
• Resourceful and adept at seeking or collecting and synthesizing information from a variety of clients and sources in an objective, unbiased manner in order to reach a sound conclusion, goal, or judgment.
• Collaborative spirits eager to actively participate as a member of a team contributing successfully to the completion of goals and objectives aligned with the mission, vision and values of the Behavioral Health Care Services system of care.
• Practiced problem solvers capable of making well supported decisions by  identifying and understanding issues, problems, and opportunities; comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action; and solving problems by taking action that is consistent with available facts, constraints, and probable consequences.
• Well organized, capable of multi-tasking and planning daily work activities, and establishing a course of action for self and others to ensure that work is completed efficiently.
• An effective communicator who conveys information and ideas verbally and in writing in a manner that meets audience needs; and develops and maintains effective relationships with others by relating well to people with diverse cultures, interpersonal styles, abilities, motivations, or backgrounds.

For a detailed listing of the duties and essential competency requirements for this position, please see the complete Clinical Review Specialist job description.   

Education:

Possession of a Master’s Degree from an accredited college or university in Social Work, Marriage and Family Therapy, Psychiatric Nursing, with an emphasis in Clinical Social Work, or equivalent degree which meets requirements set by the California Board of Behavioral Sciences;

OR

A Ph.D. in clinical, counseling, or educational psychology from an accredited college or university.

NOTE: Completion of an accredited registered nursing program, including three years post licensed nursing experience may be substituted for a Master’s degree in nursing.

AND

Experience:

The equivalent of three years of full-time, paid post-license experience in direct behavioral health care that includes treatment and disposition planning and/or the clinical review of these direct mental health and substance use disorder services.

License/Registration:

Possession of a valid clinical license from the applicable licensing authority: California Board of Behavioral Sciences, California Board of Psychology, or California Board of Registered Nursing.

Possession of a valid California Motor Vehicle Operator’s license. Applicants must possess such license prior to appointment to such positions.

Special Requirement:

In compliance with the Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), employees in this classification are required to possess a National Provider Identifier (NPI) number prior to their first day on the job.

The most suitably qualified candidates will possess the following competencies:

Knowledge of:

• Social and behavioral aspects of mental, emotional, substance use disorder (SUD)-related disturbances and their characteristics.
• Principles and practices of direct client service delivery.
• Scope, activities and functions of the various behavioral health facilities and public and private community agencies providing services to mental health and substance use disorder clients.
• Policies, procedures, and systems related to Behavioral Health Care Services, legal and regulatory requirements and limitations.
• Applicable federal, state and local laws, rules and regulations.
• Computer applications related to the work.

Ability to:

• Evaluate cases and perform advanced differential diagnosis of a mental disorder.
• Evaluate cases and perform advanced clinical risk assessment.
• Communicate effectively and document the biopsychosocial basis for triage, referral and authorization decisions.
• Communicate effectively selection factors related to a broad range of behavioral health care intervention modalities.
• Organize and prioritize work, and meet critical deadlines.
• Maintain accurate records and files.
• Input and/or access data via system-wide network computers and personal computers.
• Prepare clear, accurate and effective reports, correspondence and other written materials.
• Interpret, explain and apply complex regulations, policies and procedures.
• Effectively utilize community resources in the care of individuals with mental or substance use disorders.
• Establish and maintain effective working relationships with those contacted in the course of work.

THE EXAMINATION WILL CONSIST OF the following steps: 1) A review of candidates' applications to verify possession of minimum requirements. Those candidates who possess the minimum requirements for the class will move on to the next step in the examination process. 2) A review of candidates’ Supplemental Questionnaires to select the best qualified applicants to continue in the process.  3) An oral interview which will be weighted as 100% of the candidate's final examination score. The oral interview may contain situational exercises.  CANDIDATES MUST ATTAIN A QUALIFYING RATING ON EACH PORTION OF THIS EXAMINATION. 

            We reserve the right to make changes to the announced examination components.

Alameda County utilizes a Civil Service Selection System founded on merit.  Such a system is competitive and based on broad recruitment efforts and equal opportunity for qualified applicants to test in an examination process designed to determine the qualifications, fitness and ability of competitors to perform duties of the vacant position.  Many of our recruitments are targeted and specific to the needs of a current vacant position, in which case, the eligible list may be exclusively used for that current vacant position.  Other recruitments many be more broadly used for both current and future vacancies, or for other alternate jobs with comparable scopes of work.

Alameda County offers a comprehensive and competitive benefits package that affords wide-ranging health care options to meet the different needs of a diverse workforce and their families. We also sponsor many different employee discount, fitness and health screening programs focused on overall well being.  These benefits include but are not limited to*:

For your Health & Welfare Benefits

• Medical – HMO & PPO Insurance
• Dental – PPO & DHMO Insurance  
• Vision
• Basic Life Insurance 
• Supplemental Life Insurance (with optional dependent coverage) 
• County Allowance
• Health Flexible Spending Account
• Dependent Care Flexible Spending Account
• Accident, Critical Illness & Hospital Indemnity
• Long Term Care Insurance
• Employee Assistance Program

For your Financial Future

• Short-term Disability Insurance
• Long-Term Disability Insurance
• Retirement Plan – (Defined Benefit Pension Plan)
• Deferred Compensation Plan

For your Work/Life Balance

• 11 paid holidays
• Vacation and sick leave accrual
• Vacation purchase program
• Management Paid Leave**
• Group Auto/Home
• Commuter Benefits Program
• Guaranteed Ride Home
• Employee Wellness Program (e.g. At Work Fitness, Incentive Based Programs, Gym Membership Discounts)
• Employee Discount Program (e.g. theme parks, cell phone, etc.)
• Child Care Resources
• 1^st United Services Credit Union 

*Eligibility is determined by Alameda County and offerings may vary by collective bargaining agreement.  This provides a brief summary of the benefits offered and can be subject to change.

** Non-exempt management employees are entitled to up to three days of management paid leave. Exempt management employees are entitled to up to seven days of management paid leave.

All notices related to County recruitments for which you have applied will be sent/delivered via email. Please add @acgov.org and alamedacountyHR@acgov.org as accepted addresses to any email blocking or spam filtering program you may use. If you do not do this, your email blocking or spam filtering program may block receipt of the notices regarding your application for recruitments. You are also strongly advised to regularly log into your County of Alameda online application account to check for notices that may have been sent to you. All email notices that will be sent to you will also be kept in your personal online application account. You will be able to view all of your notices in your online application account by clicking on the "My applications" button on the Current Job Openings page.

Please take the steps recommended above to insure you do not miss any notices about a recruitment for which you have applied. The County of Alameda is not responsible for notices that are not read, received or accessed by any applicant for a County recruitment.

NOTE: All notices are generated through an automated email notification system. Replies to the email box alamedacountyHR@acgov.org are routed to an unmonitored mailbox. If you have questions please go to our website at www.acgov.org/hrs. You may also contact the Human Resources Analyst listed on the bulletin for the recruitment for which you have applied.

Sylvia Perez
Human Resources Analyst
Human Resource Services Division-County of Alameda
510-208-9593
www.acgov.org